• Oluwaseun O Akinduro, Neethu Gopal, Tasneem F Hasan, Emad Nourollah-Zadeh, Kunal Vakharia, Reade De Leacy, Jan-Karl Burkhardt, Junichi Yamamoto, J Mocco, Leonardo Rangel Castilla, Tze Man KanPeterPDepartment of Neurological Surgery, Baylor College of Medicine, Houston, Texas., Alan Boulos, Elad Levy, and Rabih G Tawk.
• Department of Neurological Surgery, Mayo Clinic, Jacksonville, Florida.
• Neurosurgery. 2020 Sep 15; 87 (4): 770-778.

BackgroundThere is a paucity of literature regarding treatment options for extracranial pseudoaneurysms of the internal carotid artery (ICA). To date, Pipeline Embolization Device (PED; Medtronic Inc) use for the treatment of extracranial pseudoaneurysms of the ICA has only been reported from single-center case series.ObjectiveTo evaluate the safety and efficacy of PED for the treatment of extracranial ICA pseudoaneurysms.MethodsThis is a multicenter retrospective study involving 6 high-volume tertiary academic institutions in the United States. We analyzed patients with extracranial ICA pseudoaneurysms treated with PED between January 1, 2011, and January 1, 2019. Clinical assessment was performed pre- and postintervention using the modified Rankin Scale (mRS) and National Institution of Health Stroke Scale (NIHSS) at a minimum of 4-mo follow-up.ResultsA total of 28 pseudoaneurysms with a mean diameter of 17.7 mm (range: 4.1-52.5 mm) were treated with PED in 24 patients at 6 participating centers. The mean age was 52.1 yr (17-73) ± 14.3 with 14 females and 10 males. At a mean of 21-mo (range 4-66 mo) follow-up, complete occlusion was achieved in 89% (n = 25/28), with near-complete occlusion (>90% occlusion) in the remainder. There were no periprocedural complications. Postprocedure NIHSS was 0 in 88% (n = 21/24) and 1 in 12% (n = 3/24) of patients, and mRS was 0 in 83% (n = 20/24) and 1 in 17% (n = 4/24) of patients.ConclusionThe treatment of extracranial ICA pseudoaneurysms with PED is safe and effective in selected patients. Randomized controlled trials and prospective cohort studies are needed to establish the role of flow diversion for ICA pseudoaneurysms.Copyright © 2020 by the Congress of Neurological Surgeons.

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